Michelle Muscat MD MRCS(Ed) MSc, PG Dip, FRCPath, PhD

      Artist: Sheryl Crow

      Genre: original motion picture soundtrack / pop

Runtime: 4.39 minutes

Released: 2006

 

Post-traumatic stress disorder’s (PTSD) diagnosis has long been the remit of psychiatrists and Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. This brief article will describe Sheryl Crow’s song “Try not to remember” in association with the intrusive memories of PTSD, as well as focus on newer diagnostic avenues where serological biomarkers are being studied as potential more objective diagnostic tools of the condition.

Sheryl Crow’s song “Try not to remember” from the movie “Home of the Brave” (2006), directed by Irwin Winkler, is both a pleasure to listen to, while at the same time conveying a central theme. Both the events in the movie and the song itself illustrate post-traumatic stress disorder (PTSD) which was experienced by the veterans portrayed. The song places great emphasis on the intrusive reminders associated with the condition.

The lyrics state:

“In the still of the night

Do you laugh, do you cry?

Do you try not to remember?

 

If it’s a question of fate

Do you love, do you hate?

Do you try not to remember?”

 

PTSD tends to occur in the aftermath of exceptionally traumatic incidents such as bombings, wars, natural disasters or other severely tragic events. For many years the diagnosis hinged strongly on clinical acumen after history and examination, and fulfillment of certain DSM psychiatric criteria. Worthy of note is that it has been recently somewhat reclassified in the fifth edition of DSM. A more objective biomarker however would be preferred, if available, to help elucidate the diagnosis and even, possibly, potential susceptibility to PTSD.(1) Recently, more articles are emerging in the literature, of this search for a biomarker in association with PTSD. Both serological biomarkers and advanced imaging techniques, if further elucidated, and brought into routine clinical practice, would provide more definite and objective evidence than ever before.(2) Blood-based mRNA-expression and select small nucleolar RNAs have been looked into. (3, 4) A mouse model was also devised to this purpose.(5) The neurobiology and epigenetics of PTSD are being further studied.(6) Novel biomarkers such as midregional proadrenomedullin (MR-proADM) and C-terminal proendothelin-1 have been investigated in relation to mortality.(7) The emergence of more translational research has the propensity to potentially, if successful, in the coming years, shift diagnostic paradigms. (8-10) A potential association between CRP and PTSD had been recorded (11), hair cortisol concentration fluctuations have also been studied in relation to PTSD (12, 13), as well as many other novel biomarkers such as for example p11. (14)

This review is partially funded through the Endeavour Scholarship Scheme

Selected References

  1. Andrews JA, Neises KD. Cells, biomarkers, and post-traumatic stress disorder: evidence for peripheral involvement in a central disease. J Neurochem. 2012;120(1):26-36.
  2. Huang M, Risling M, Baker DG. The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury. Psychoneuroendocrinology. 2016;63:398-409.
  3. Tylee DS, Chandler SD, Nievergelt CM, Liu X, Pazol J, Woelk CH, et al. Blood-based gene-expression biomarkers of post-traumatic stress disorder among deployed marines: A pilot study. Psychoneuroendocrinology. 2015;51:472-94.
  4. Ho L, Lange G, Zhao W, Wang J, Rooney R, Patel DH, et al. Select small nucleolar RNAs in blood components as novel biomarkers for improved identification of comorbid traumatic brain injury and post-traumatic stress disorder in veterans of the conflicts in Afghanistan and Iraq. Am J Neurodegener Dis. 2014;3(3):170-81.
  5. Yang R, Daigle BJ, Jr., Muhie SY, Hammamieh R, Jett M, Petzold L, et al. Core modular blood and brain biomarkers in social defeat mouse model for post traumatic stress disorder. BMC Syst Biol. 2013;7:80.
  6. Maddox SA, Schafe GE, Ressler KJ. Exploring epigenetic regulation of fear memory and biomarkers associated with post-traumatic stress disorder. Front Psychiatry. 2013;4:62.
  7. Xue Y, Taub PR, Iqbal N, Fard A, Wentworth B, Redwine L, et al. Cardiac biomarkers, mortality, and post-traumatic stress disorder in military veterans. Am J Cardiol. 2012;109(8):1215-8.
  8. Michopoulos V, Norrholm SD, Jovanovic T. Diagnostic Biomarkers for Posttraumatic Stress Disorder: Promising Horizons from Translational Neuroscience Research. Biol Psychiatry. 2015;78(5):344-53.
  9. Schmidt U, Kaltwasser SF, Wotjak CT. Biomarkers in posttraumatic stress disorder: overview and implications for future research. Dis Markers. 2013;35(1):43-54.
  10. Kang HJ, Yoon S, Lyoo IK. Peripheral Biomarker Candidates of Posttraumatic Stress Disorder. Exp Neurobiol. 2015;24(3):186-96.
  11. Eraly SA, Nievergelt CM, Maihofer AX, Barkauskas DA, Biswas N, Agorastos A, et al. Assessment of plasma C-reactive protein as a biomarker of posttraumatic stress disorder risk. JAMA Psychiatry. 2014;71(4):423-31.
  12. Steudte S, Kirschbaum C, Gao W, Alexander N, Schonfeld S, Hoyer J, et al. Hair cortisol as a biomarker of traumatization in healthy individuals and posttraumatic stress disorder patients. Biol Psychiatry. 2013;74(9):639-46.
  13. Luo H, Hu X, Liu X, Ma X, Guo W, Qiu C, et al. Hair cortisol level as a biomarker for altered hypothalamic-pituitary-adrenal activity in female adolescents with posttraumatic stress disorder after the 2008 Wenchuan earthquake. Biol Psychiatry. 2012;72(1):65-9.
  14. Zhang L, Ursano RJ, Li H. P11: a potential biomarker for posttraumatic stress disorder. Methods Mol Biol. 2012;829:453-68.